There are limited data on the prevalence and treatment of familial hypercholesterolemia
(FH) among Israeli adults who experience premature acute coronary syndrome (ACS).
This study aimed to assess the prevalence of FH among young Israeli adults with ACS,
examine the rates of lipid-lowering therapy administration, and determine low-density
lipoprotein-cholesterol (LDL-C) levels 1 year after ACS. Patients aged ≤55 years hospitalized
for ACS at Meir Medical Center between 2018 and 2019 were included. Probable/definite
FH was defined using the Dutch Lipid Clinic criteria. Outcomes included the proportion
of patients with probable or definite FH, rate of use of lipid-lowering medications,
LDL-C levels 1 year postadmission, and major adverse cardiovascular and cerebrovascular
events during 30 months of follow-up. The study population comprised 687 young adults
with a median age of 48.5 years. Definite/probable FH was present in 61 patients (8.9%).
At 1 year of follow-up, the proportions of patients without FH who had LDL-C levels
<70 and <55 mg/100 ml were higher than those of patients with FH (55.9% vs 18%, p
<0.001 and 35.8% vs 11.5%, p <0.001, respectively). At 1 year of follow-up, only 47.5%
and 22% of patients with FH were treated with ezetimibe and proprotein convertase
subtilisin/kexin type 9 inhibitor than were those without FH. The incidence of major
adverse cardiovascular and cerebrovascular events was significantly higher among patients
with FH. In conclusion, clinically defined FH was present in nearly 1 of 11 patients
with premature ACS. There is a necessity for more aggressive lipid-lowering therapies
in patients with FH after experiencing ACS.
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References
- Barriers to the identification of familial hypercholesterolemia among primary care providers.J Community Genet. 2019; 10: 229-236
- Homozygous autosomal dominant hypercholesterolaemia in the Netherlands: prevalence, genotype-phenotype relationship, and clinical outcome.Eur Heart J. 2015; 36: 560-565
- The characteristics of patients with possible familial hypercholesterolemia-screening a large payer/provider healthcare delivery system.QJM. 2020; 113: 411-417
- Familial hypercholesterolemia.Cardiol Clin. 2015; 33: 169-179
- Challenges in the diagnosis and treatment of homozygous familial hypercholesterolemia.Drugs. 2015; 75: 1715-1724
- 2018 American Heart Association/American College of Cardiology/Multisociety Guideline on the management of blood cholesterol-secondary prevention.JAMA Cardiol. 2019; 4: 589-591
- ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk [published correction appears in Eur Heart J 2020;41:4255].Eur Heart J. 2020; 41: 111-188
- Prevalence and predictors of cholesterol screening, awareness, and statin treatment among US adults with familial hypercholesterolemia or other forms of severe dyslipidemia (1999-2014).Circulation. 2018; 137: 2218-2230
- Familial hypercholesterolemia among young adults with myocardial infarction.J Am Coll Cardiol. 2019; 73: 2439-2450
- Prognosis of patients with familial hypercholesterolemia after acute coronary syndromes.Circulation. 2016; 134: 698-709
- Efficacy of statins in familial hypercholesterolaemia: a long term cohort study.BMJ. 2008; 337: a2423
- SAFEHEART Investigators. Attainment of LDL-cholesterol treatment goals in patients with familial hypercholesterolemia: 5-year SAFEHEART registry follow-up.J Am Coll Cardiol. 2016; 67: 1278-1285
- 2012 ESC Guidelines on acute myocardial infarction (STEMI).Eur Heart J. 2012; 33: 2501-2502
- ESC Scientific Document Group. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2016; 37: 267-315
- Prevalence and management of familial hypercholesterolaemia in patients with acute coronary syndromes.Eur Heart J. 2015; 36: 2438-2445
- Estimating the prevalence of familial hypercholesterolemia in acute coronary syndrome: a systematic review and meta-analysis.Can J Cardiol. 2019; 35: 1322-1331
- Tybjærg-Hansen A; European Atherosclerosis Society Consensus Panel. Familial hypercholesterolemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. [published correction appears in Eur Heart J 2020;41:4517].Eur Heart J. 2013; 34: 3478-3490a
- Familial hypercholesterolemia in the danish general population: prevalence, coronary artery disease, and cholesterol-lowering medication [published correction appears in J Clin Endocrinol Metab 2014;99:4758–4759].J Clin Endocrinol Metab. 2012; 97: 3956-3964
- Prevalence of Familial Hypercholesterolemia in the 1999 to 2012 United States National Health and Nutrition Examination Surveys (NHANES).Circulation. 2016; 133: 1067-1072
- Centro Studi e Formazione - Italian Association for Cardiovascular Prevention and Rehabilitation. Prevalence and management of familial hypercholesterolemia in patients with coronary artery disease: the heredity survey.Int J Cardiol. 2018; 252: 193-198
- Vulic D; EUROASPIRE Investigators. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.Eur J Prev Cardiol. 2016; 23: 636-648
- Prevalence of familial hypercholesterolemia in patients with acute coronary syndrome in Japan: results of the EXPLORE-J study.Atherosclerosis. 2018; 277: 362-368
- Familial hypercholesterolemia is undertreated in clinical practice.Hellenic J Atheroscler. 2016; 7: 120-130
- Califf RM; IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015; 372: 2387-2397
- ODYSSEY OUTCOMES Committees and Investigators. Effect of alirocumab on lipoprotein(a) and cardiovascular risk after acute coronary syndrome.J Am Coll Cardiol. 2020; 75: 133-144
- HEART-UK LDL Apheresis Working Group. Recommendations for the use of LDL apheresis.Atherosclerosis. 2008; 198: 247-255
- Lipid apheresis, indications, and principles.J Clin Apher. 2011; 26: 269-275
- Updated Israeli guidelines for the treatment of dyslipidemia 2020.Harefuah. 2021; 160: 38-44
- A highly durable RNAi therapeutic inhibitor of PCSK9.N Engl J Med. 2017; 376: 41-51
- ORION-9 Investigators. Inclisiran for the treatment of heterozygous familial hypercholesterolemia.N Engl J Med. 2020; 382: 1520-1530
- EUROASPIRE V collaborators; Writing Committee; Scientific Steering/Executive Committee; Coordinating centre; Diabetes centre; Data management centre; Statistical analysis centre; Central laboratory; Study centres, organisations, investigators and other research personnel (National Co-ordinators in each country are indicated by asterisk). Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries.Atherosclerosis. 2019; 285: 135-146
- DA VINCI study. EU-wide cross-sectional observational study of lipid-modifying therapy use in secondary and primary care: the DA VINCI study.Eur J Prev Cardiol. 2021; 28: 1279-1289
- 2016 ACC Expert Consensus Decision Pathway on the role of non-Statin therapies for LDL-Cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents.J Am Coll Cardiol. 2016; 68: 92-125
- Gender disparities in health resource utilization in patients with atherosclerotic cardiovascular disease: a retrospective cross-sectional study.Adv Ther. 2019; 36: 3424-3434
- Cardiovascular risk stratification in familial hypercholesterolaemia.Heart. 2016; 102: 1003-1008
- High burden of recurrent cardiovascular events in heterozygous familial hypercholesterolemia: the French familial hypercholesterolemia registry.Atherosclerosis. 2018; 277: 334-340
- Relation of low-density lipoprotein cholesterol level to plaque rupture.Am J Cardiol. 2020; 134: 48-54
- Diagnostic yield and clinical utility of sequencing familial hypercholesterolemia genes in patients with severe hypercholesterolemia.J Am Coll Cardiol. 2016; 67: 2578-2589
Article info
Publication history
Published online: October 19, 2022
Received in revised form:
September 11,
2022
Received:
June 28,
2022
Footnotes
Funding: none
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